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Hooijberg F, Layegh Z, Leeuw M, Boekel L, van den Berg SPH, Ruwaard J, Bastida C, Huitema ADR, Pel S, Elkayam O, de Vries A, Nurmohamed M, Rispens T, Dorlo TPC, Wolbink G. Tocilizumab Dose Tapering Based on a Model-Based Algorithm is Feasible in Clinical Practice: A Short Communication. Ther Drug Monit 2024; 46:410-414. [PMID: 38287880 DOI: 10.1097/ftd.0000000000001168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Accepted: 09/13/2023] [Indexed: 01/31/2024]
Abstract
BACKGROUND Tocilizumab in the treatment of rheumatoid arthritis (RA) is a potential candidate for concentration-guided tapering because the standard dose of tocilizumab results in a wide range of serum concentrations, usually above the presumed therapeutic window, and an exposure-response relationship has been described. However, no clinical trials have been published to date on this subject. Therefore, the objective of this study was to assess the feasibility of the tapering of intravenous (iv) tocilizumab with the use of a pharmacokinetic model-based algorithm in RA patients. METHODS A randomized controlled trial with a double-blind design and follow-up of 24 weeks was conducted. RA patients who received the standard of tocilizumab for at least the past 24 weeks, which is 8 mg/kg every 4 weeks, were included. Patients with a tocilizumab serum concentration above 5 mg/L at trough were randomized between concentration-guided dose tapering, referred to as therapeutic drug monitoring (TDM), or the standard 8 mg/kg dose. In the TDM group, the tocilizumab dose was tapered with a recently published model-based algorithm to achieve a target concentration of 4-6 mg/L after 20 weeks of dose tapering. RESULTS Twelve RA patients were included and 10 were randomized between the TDM and standard dose group. The study was feasible regarding the predefined feasibility criteria and patients had a positive attitude toward therapeutic drug monitoring. In the TDM group, the tocilizumab trough concentration within patients decreased on average by 24.5 ± 18.3 mg/L compared with a decrease of 2.8 ± 12 mg/L in the standard dose group. None of the patients in the TDM group reached the drug range of 4-6 mg/L. Instead, tocilizumab concentrations of 1.6 and 1.5 mg/L were found for the 2 patients who completed follow-up on the tapered dose. No differences in RA disease activity were observed between the 2 study groups. CONCLUSIONS This study was the first to show that it is feasible to apply a dose-reduction algorithm based on a pharmacokinetic model in clinical practice. However, the current algorithm needs to be optimized before it can be applied on a larger scale.
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Affiliation(s)
- Femke Hooijberg
- Department of Rheumatology, Amsterdam Rheumatology and Immunology Center, Location Reade, Amsterdam, the Netherlands
- Department of Rheumatology, Amsterdam UMC, Location VUmc, Amsterdam, the Netherlands
| | - Zohra Layegh
- Department of Rheumatology, Amsterdam Rheumatology and Immunology Center, Location Reade, Amsterdam, the Netherlands
- Department of Rheumatology, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Maureen Leeuw
- Department of Rheumatology, Amsterdam Rheumatology and Immunology Center, Location Reade, Amsterdam, the Netherlands
| | - Laura Boekel
- Department of Rheumatology, Amsterdam Rheumatology and Immunology Center, Location Reade, Amsterdam, the Netherlands
| | - Stefan P H van den Berg
- Department of Immunopathology, Sanquin Research and Landsteiner Laboratory Academic Medical Center, Amsterdam, the Netherlands
| | - Jill Ruwaard
- Department of Rheumatology, Amsterdam Rheumatology and Immunology Center, Location Reade, Amsterdam, the Netherlands
| | - Carla Bastida
- Department of Pharmacy, Hospital Clinic of Barcelona, Universitat de Barcelona, Barcelona, Spain
| | - Alwin D R Huitema
- Department of Pharmacy & Pharmacology, The Netherlands Cancer Institute-Antoni van Leeuwenhoek, Amsterdam, the Netherlands
- Department of Clinical Pharmacy, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
- Department of Pharmacology, Princess Maxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - Sara Pel
- Department of Rheumatology, Tel Aviv Sourasky Medical Center, Tel Aviv-Yafo, Israel; and
| | - Ori Elkayam
- Department of Rheumatology, Tel Aviv Sourasky Medical Center, Tel Aviv-Yafo, Israel; and
| | - Annick de Vries
- Department of Immunopathology, Sanquin Research and Landsteiner Laboratory Academic Medical Center, Amsterdam, the Netherlands
| | - Mike Nurmohamed
- Department of Rheumatology, Amsterdam Rheumatology and Immunology Center, Location Reade, Amsterdam, the Netherlands
- Department of Rheumatology, Amsterdam UMC, Location VUmc, Amsterdam, the Netherlands
| | - Theo Rispens
- Department of Immunopathology, Sanquin Research and Landsteiner Laboratory Academic Medical Center, Amsterdam, the Netherlands
| | | | - Gertjan Wolbink
- Department of Rheumatology, Amsterdam Rheumatology and Immunology Center, Location Reade, Amsterdam, the Netherlands
- Department of Immunopathology, Sanquin Research and Landsteiner Laboratory Academic Medical Center, Amsterdam, the Netherlands
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Eviatar T, Furer V, Polachek A, Zisman D, Peleg H, Elalouf O, Levartovsky D, Kaufman I, Broyde A, Haddad A, Feld J, Aassi M, Quebe-Fehling E, Alarcon I, Pel S, Paran D, Elkayam O. Effect of Secukinumab and Tumor Necrosis Factor Inhibitors on Humoral Response to BNT162b2 mRNA Vaccine in Patients With Spondyloarthritis Compared to Immunocompetent Controls. J Rheumatol 2024; 51:415-422. [PMID: 37914221 DOI: 10.3899/jrheum.2023-0357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/06/2023] [Indexed: 11/03/2023]
Abstract
OBJECTIVE To assess the humoral response to the BNT162b2 mRNA vaccine among patients with spondyloarthritis (SpA) receiving secukinumab (SEC) compared to those receiving tumor necrosis factor inhibitors (TNFi) and immunocompetent controls. METHODS Consecutive patients with psoriatic arthritis or axial SpA receiving SEC (n = 37) or TNFi (monotherapy, n = 109; + methotrexate [MTX], n = 16), immunocompetent controls (n = 122), and patients with rheumatoid arthritis (RA) receiving TNFi therapy (controls, n = 50) were vaccinated with 2 or 3 doses of the BNT162b2 vaccine. We evaluated humoral response, adverse events, and disease activity, and monitored for breakthrough coronavirus disease 2019 (COVID-19) postvaccination. RESULTS The 2-dose vaccine regimen induced a comparable seropositive response in all study groups. S1/S2 antibody titers (in binding antibody units/mL; mean [SD]) were higher in the SEC group vs the TNFi + MTX-SpA and TNFi-RA groups (192.5 [68.4] vs 104.6 [46.9], P < 0.001, and 143.1 [81.9], P = 0.004). After 6 months, 96.3%, 96.6%, and 80.9% of the SEC, immunocompetent, and TNFi monotherapy-SpA groups (P = 0.10), respectively; 66.7% of the TNFi + MTX-SpA group (P = 0.03); and 63% of the TNFi-RA group (P = 0.004) remained seropositive. S1/S2 antibody titer decline was steeper in the TNFi groups than the SEC group. After the third dose, 100% of the SpA and immunocompetent and 88.9% of the TNFi-RA (P = 0.25) groups were seropositive. Rate of breakthrough COVID-19 infection was higher in the TNFi groups than in the SEC group (36-37.5% vs 10.8%). No significant between-group differences were observed for postvaccination disease activity and adverse events. CONCLUSION SEC did not interfere with the immunogenic response to BNT162b2 vaccine in patients with SpA; however, TNFi therapy was associated with lower S1/S2-antibody titers, faster decline, and higher rate of breakthrough infections.
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Affiliation(s)
- Tali Eviatar
- T. Eviatar, MD, V. Furer, MD, A. Polachek, MD, O. Elalouf, MD, D. Levartovsky, MD, I. Kaufman, MD, A. Broyde, MD, S. Pel, MPH, D. Paran, MD, O. Elkayam, MD, Rheumatology Department, Tel Aviv Sourasky Medical Center and Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel;
| | - Victoria Furer
- T. Eviatar, MD, V. Furer, MD, A. Polachek, MD, O. Elalouf, MD, D. Levartovsky, MD, I. Kaufman, MD, A. Broyde, MD, S. Pel, MPH, D. Paran, MD, O. Elkayam, MD, Rheumatology Department, Tel Aviv Sourasky Medical Center and Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ari Polachek
- T. Eviatar, MD, V. Furer, MD, A. Polachek, MD, O. Elalouf, MD, D. Levartovsky, MD, I. Kaufman, MD, A. Broyde, MD, S. Pel, MPH, D. Paran, MD, O. Elkayam, MD, Rheumatology Department, Tel Aviv Sourasky Medical Center and Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Devy Zisman
- D. Zisman, MD, A. Haddad, MD, J. Feld, MD, Rheumatology Unit, Carmel Hospital, and Faculty of Medicine, Technion Israel Institute of Technology, Haifa, Israel
| | - Hagit Peleg
- H. Peleg, MD, Rheumatology Unit, Hadassah University Hospital, and the Hebrew University of Jerusalem Faculty of Medicine, Jerusalem, Jerusalem, Israel
| | - Ofir Elalouf
- T. Eviatar, MD, V. Furer, MD, A. Polachek, MD, O. Elalouf, MD, D. Levartovsky, MD, I. Kaufman, MD, A. Broyde, MD, S. Pel, MPH, D. Paran, MD, O. Elkayam, MD, Rheumatology Department, Tel Aviv Sourasky Medical Center and Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - David Levartovsky
- T. Eviatar, MD, V. Furer, MD, A. Polachek, MD, O. Elalouf, MD, D. Levartovsky, MD, I. Kaufman, MD, A. Broyde, MD, S. Pel, MPH, D. Paran, MD, O. Elkayam, MD, Rheumatology Department, Tel Aviv Sourasky Medical Center and Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ilana Kaufman
- T. Eviatar, MD, V. Furer, MD, A. Polachek, MD, O. Elalouf, MD, D. Levartovsky, MD, I. Kaufman, MD, A. Broyde, MD, S. Pel, MPH, D. Paran, MD, O. Elkayam, MD, Rheumatology Department, Tel Aviv Sourasky Medical Center and Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Adi Broyde
- T. Eviatar, MD, V. Furer, MD, A. Polachek, MD, O. Elalouf, MD, D. Levartovsky, MD, I. Kaufman, MD, A. Broyde, MD, S. Pel, MPH, D. Paran, MD, O. Elkayam, MD, Rheumatology Department, Tel Aviv Sourasky Medical Center and Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Amir Haddad
- D. Zisman, MD, A. Haddad, MD, J. Feld, MD, Rheumatology Unit, Carmel Hospital, and Faculty of Medicine, Technion Israel Institute of Technology, Haifa, Israel
| | - Joy Feld
- D. Zisman, MD, A. Haddad, MD, J. Feld, MD, Rheumatology Unit, Carmel Hospital, and Faculty of Medicine, Technion Israel Institute of Technology, Haifa, Israel
| | - Maher Aassi
- M. Aassi, MD, E. Quebe-Fehling, PhD, I. Alarcon, MD, Novartis Pharma AG, Medical Affairs, Basel, Switzerland
| | - Erhard Quebe-Fehling
- M. Aassi, MD, E. Quebe-Fehling, PhD, I. Alarcon, MD, Novartis Pharma AG, Medical Affairs, Basel, Switzerland
| | - Ivette Alarcon
- M. Aassi, MD, E. Quebe-Fehling, PhD, I. Alarcon, MD, Novartis Pharma AG, Medical Affairs, Basel, Switzerland
| | - Sara Pel
- T. Eviatar, MD, V. Furer, MD, A. Polachek, MD, O. Elalouf, MD, D. Levartovsky, MD, I. Kaufman, MD, A. Broyde, MD, S. Pel, MPH, D. Paran, MD, O. Elkayam, MD, Rheumatology Department, Tel Aviv Sourasky Medical Center and Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Daphna Paran
- T. Eviatar, MD, V. Furer, MD, A. Polachek, MD, O. Elalouf, MD, D. Levartovsky, MD, I. Kaufman, MD, A. Broyde, MD, S. Pel, MPH, D. Paran, MD, O. Elkayam, MD, Rheumatology Department, Tel Aviv Sourasky Medical Center and Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ori Elkayam
- T. Eviatar, MD, V. Furer, MD, A. Polachek, MD, O. Elalouf, MD, D. Levartovsky, MD, I. Kaufman, MD, A. Broyde, MD, S. Pel, MPH, D. Paran, MD, O. Elkayam, MD, Rheumatology Department, Tel Aviv Sourasky Medical Center and Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Heshin-Bekenstein M, Ziv A, Toplak N, Lazauskas S, Kadishevich D, Ben-Nun Yaari E, Miller-Barmak A, Butbul Aviel Y, Saiag E, Pel S, Elkayam O, Uziel Y, Furer V. Safety and Immunogenicity Following the Second and Third Doses of the BNT162b2 mRNA COVID-19 Vaccine in Adolescents with Juvenile-Onset Autoimmune Inflammatory Rheumatic Diseases: A Prospective Multicentre Study. Vaccines (Basel) 2023; 11:vaccines11040819. [PMID: 37112731 PMCID: PMC10145688 DOI: 10.3390/vaccines11040819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2023] [Revised: 03/28/2023] [Accepted: 03/30/2023] [Indexed: 04/29/2023] Open
Abstract
BACKGROUND To explore the long-term safety and dynamics of the immune response induced by the second and third doses of the BNT162b2 mRNA COVID-19 vaccine in adolescents with juvenile-onset autoimmune inflammatory rheumatic diseases (AIIRDs) compared with healthy controls. METHODS This international prospective study included adolescents with AIIRDs and controls vaccinated with two (AIIRDs n = 124; controls n = 80) or three (AIIRDs n = 64; controls n = 30) doses of the BNT162b2 vaccine, evaluated for vaccine side-effects, disease activity, COVID-19 breakthrough infection rates and severity, and anti-spike S1/S2 IgG antibody titers in a sample from both groups. RESULTS The vaccination safety profile was favorable, with most patients reporting mild or no side-effects. The rheumatic disease remained stable at 98% and 100% after the second and third doses, respectively. The two-dose vaccine induced comparable seropositivity rates among patients (91%) and controls (100%), (p = 0.55), which declined within 6 months to 87% and 100%, respectively (p = 0.3) and increased to 100% in both groups after the third vaccine dose. The overall post-vaccination COVID-19 infection rate was comparable between patients and controls, 47.6% (n = 59) and 35% (n = 28), respectively; p = 0.5278, with most infections occurring during the Omicron surge. In relation to the last vaccination, time-to-COVID-19 infection was similar between patients and controls, at a median of 5.5 vs. 5.2 months, respectively (log-rank p = 0.1555). CONCLUSION The safety profile of three doses of the BNT162b2 mRNA vaccine was excellent, with adequate humoral response and similar efficacy among patients and controls. These results support the recommendation for vaccinating adolescents with juvenile-onset AIIRDs against COVID-19.
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Affiliation(s)
- Merav Heshin-Bekenstein
- Pediatric Rheumatology Service, Dana-Dwek Children's Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv 6423906, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Amit Ziv
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
- Pediatric Rheumatology Unit, Meir Medical Center, Kfar Saba 4428164, Israel
| | - Natasa Toplak
- Department of Allergology, Rheumatology and Clinical Immunology, University Children's Hospital, University Medical Center Ljubljana, 1000 Ljubljana, Slovenia
- Faculty of Medicine, University of Ljubljana, 1000 Ljubljana, Slovenia
| | - Siman Lazauskas
- Pediatric Department, Dana-Dwek Children's Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv 6423906, Israel
| | | | | | - Adi Miller-Barmak
- Pediatric Rheumatology Unit, Rambam Medical Center, Haifa 3109601, Israel
| | | | - Esther Saiag
- Hospital Management, Information and Operation Branch, Tel Aviv Sourasky Medical Center, Tel Aviv 6997801, Israel
| | - Sara Pel
- Rheumatology Department, Tel Aviv Sourasky Medical Center, Tel Aviv 6423906, Israel
| | - Ori Elkayam
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
- Rheumatology Department, Tel Aviv Sourasky Medical Center, Tel Aviv 6423906, Israel
| | - Yosef Uziel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
- Pediatric Rheumatology Unit, Meir Medical Center, Kfar Saba 4428164, Israel
| | - Victoria Furer
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
- Rheumatology Department, Tel Aviv Sourasky Medical Center, Tel Aviv 6423906, Israel
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4
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Furer V, Eviatar T, Freund T, Peleg H, Paran D, Levartovsky D, Kaufman I, Broyde A, Elalouf O, Polachek A, Feld J, Haddad A, Gazitt T, Elias M, Higazi N, Kharouf F, Gertel S, Pel S, Nevo S, Hagin D, Zisman D, Elkayam O. Immunogenicity induced by two and three doses of the BNT162b2 mRNA vaccine in patients with autoimmune inflammatory rheumatic diseases and immunocompetent controls: a longitudinal multicentre study. Ann Rheum Dis 2022; 81:1594-1602. [PMID: 35868846 DOI: 10.1136/ard-2022-222550] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2022] [Accepted: 07/02/2022] [Indexed: 12/27/2022]
Abstract
OBJECTIVES To evaluate long-term kinetics of the BNT162b2 mRNA vaccine-induced immune response in adult patients with autoimmune inflammatory rheumatic diseases (AIIRD) and immunocompetent controls. METHODS A prospective multicentre study investigated serum anti-SARS-CoV-2 S1/S2 IgG titre at 2-6 weeks (AIIRD n=720, controls n=122) and 6 months (AIIRD n=628, controls n=116) after the second vaccine, and 2-6 weeks after the third vaccine dose (AIIRD n=169, controls n=45). T-cell immune response to the third vaccine was evaluated in a small sample. RESULTS The two-dose vaccine regimen induced a higher humoral response in controls compared with patients, postvaccination seropositivity rates of 100% versus 84.72%, p<0.0001, and 96.55% versus 74.26%, p<0.0001 at 2-6 weeks and at 6 months, respectively. The third vaccine dose restored the seropositive response in all controls and 80.47% of patients with AIIRD, p=0.0028. All patients treated with methotrexate monotherapy, anticytokine biologics, abatacept and janus kinase (JAK) inhibitors regained the humoral response after the third vaccine, compared with only a third of patients treated with rituximab, entailing a 16.1-fold risk for a negative humoral response, p≤0.0001. Cellular immune response in rituximab-treated patients was preserved before and after the third vaccine and was similar to controls. Breakthrough COVID-19 rate during the Delta surge was similar in patients and controls, 1.83% versus 1.43%, p=1. CONCLUSIONS The two-dose BNTb262 regimen was associated with similar clinical efficacy and similar waning of the humoral response over 6 months among patients with AIIRD and controls. The third vaccine dose restored the humoral response in all of the controls and the majority of patients.
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Affiliation(s)
- Victoria Furer
- Rheumatology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel .,Tel Aviv University Sackler Faculty of Medicine, Tel Aviv, Israel
| | - Tali Eviatar
- Rheumatology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.,Tel Aviv University Sackler Faculty of Medicine, Tel Aviv, Israel
| | - Tal Freund
- Tel Aviv University Sackler Faculty of Medicine, Tel Aviv, Israel.,Allergy and Clinical Immunology Unit, Department of Medicine, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Hagit Peleg
- Rheumatology, Hadassah University Medical Center, Jerusalem, Israel
| | - Daphna Paran
- Rheumatology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.,Tel Aviv University Sackler Faculty of Medicine, Tel Aviv, Israel
| | | | - Ilana Kaufman
- Rheumatology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Adi Broyde
- Rheumatology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Ofir Elalouf
- Rheumatology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.,Tel Aviv University Sackler Faculty of Medicine, Tel Aviv, Israel
| | - Ari Polachek
- Rheumatology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.,Tel Aviv University Sackler Faculty of Medicine, Tel Aviv, Israel
| | - Joy Feld
- Carmel Medical Center, Haifa, Israel.,Medicine, Technion Israel Institute of Technology, Haifa, Israel
| | - Amir Haddad
- Carmel Medical Center, Haifa, Israel.,Medicine, Technion Israel Institute of Technology, Haifa, Israel
| | - Tal Gazitt
- Carmel Medical Center, Haifa, Israel.,Medicine, Technion Israel Institute of Technology, Haifa, Israel
| | - Muna Elias
- Carmel Medical Center, Haifa, Israel.,Medicine, Technion Israel Institute of Technology, Haifa, Israel
| | - Nizar Higazi
- Carmel Medical Center, Haifa, Israel.,Medicine, Technion Israel Institute of Technology, Haifa, Israel
| | - Fadi Kharouf
- Rheumatology, Hadassah University Medical Center, Jerusalem, Israel
| | - Smadar Gertel
- Rheumatology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.,Tel Aviv University Sackler Faculty of Medicine, Tel Aviv, Israel
| | - Sara Pel
- Rheumatology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Sharon Nevo
- Rheumatology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - David Hagin
- Tel Aviv University Sackler Faculty of Medicine, Tel Aviv, Israel.,Allergy and Clinical Immunology Unit, Department of Medicine, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Devy Zisman
- Carmel Medical Center, Haifa, Israel.,Medicine, Technion Israel Institute of Technology, Haifa, Israel
| | - Ori Elkayam
- Rheumatology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.,Tel Aviv University Sackler Faculty of Medicine, Tel Aviv, Israel
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5
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Furer V, Eviatar T, Zisman D, Peleg H, Braun-Moscovici Y, Balbir-Gurman A, Paran D, Levartovsky D, Zisapel M, Elalouf O, Kaufman I, Broyde A, Polachek A, Feld J, Haddad A, Gazitt T, Elias M, Higazi N, Kharouf F, Pel S, Nevo S, Elkayam O. Predictors of Immunogenic Response to the BNT162b2 mRNA COVID-19 Vaccination in Patients with Autoimmune Inflammatory Rheumatic Diseases Treated with Rituximab. Vaccines (Basel) 2022; 10:vaccines10060901. [PMID: 35746508 PMCID: PMC9229869 DOI: 10.3390/vaccines10060901] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2022] [Revised: 05/27/2022] [Accepted: 05/28/2022] [Indexed: 02/06/2023] Open
Abstract
Treatment with rituximab (RTX) blunts SARS-CoV-2 vaccination-induced humoral response. We sought to identify predictors of a positive immunogenic response to the BNT162b2 mRNA vaccine in patients with autoimmune inflammatory rheumatic diseases (AIIRD) treated with RTX (AIIRD-RTX). We analyzed 108 AIIRD-RTX patients and 122 immunocompetent controls vaccinated with BNT162b2 mRNA participating in a multicenter vaccination study. Immunogenicity was defined by positive anti-SARS-CoV-2 S1/S2 IgG. We used a stepwise backward multiple logistic regression to identify predicting factors for a positive immunogenic response to vaccination and develop a predicting calculator, further validated in an independent cohort of AIIRD-RTX BNT162b2 mRNA vaccinated patients (n = 48). AIIRD-RTX patients who mounted a seropositive immunogenic response significantly differed from patients who did not by a lower number of RTX courses (median (range) 3 (1–10) vs. 5 (1–15), p = 0.007; lower cumulative RTX dose (mean ± SD) 6943.11 ± 5975.74 vs. 9780.95 ± 7240.12 mg, p = 0.033; higher IgG level prior to last RTX course (mean ± SD), 1189.78 ± 576.28 vs. 884.33 ± 302.31 mg/dL, p = 0.002), and extended interval between RTX treatment and vaccination, 469.82 ± 570.39 vs. 162.08 ± 160.12 days, p = 0.0009, respectively. Patients with ANCA-associated vasculitis and inflammatory myositis had a low likelihood of a seropositive immunogenic response compared to patients with rheumatoid arthritis, odds ratio (OR) 0.209, 95% confidence interval (CI) 0.046–0.96, p = 0.044 and OR 0.189, 95% CI 0.036–0.987, p = 0.048, respectively. Based on these findings, we constructed a calculator predicting the probability of a seropositive immunogenic response following BNT162b2 mRNA vaccination which performed with 90.5% sensitivity, 59.3% specificity, and 63.3% positive and 88.9% negative predictive values. In summary, the predicting calculator could guide clinicians for optimal timing of BNT162b2 mRNA vaccination in AIIRD-RTX patients.
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Affiliation(s)
- Victoria Furer
- Rheumatology Department, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6423906, Israel; (T.E.); (D.P.); (D.L.); (M.Z.); (O.E.); (I.K.); (A.B.); (A.P.); (S.P.); (S.N.); (O.E.)
- Correspondence:
| | - Tali Eviatar
- Rheumatology Department, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6423906, Israel; (T.E.); (D.P.); (D.L.); (M.Z.); (O.E.); (I.K.); (A.B.); (A.P.); (S.P.); (S.N.); (O.E.)
| | - Devy Zisman
- Rheumatology Unit, Carmel Medical Center, Haifa 3436212, Israel; (D.Z.); (J.F.); (A.H.); (T.G.); (M.E.); (N.H.)
| | - Hagit Peleg
- Rheumatology Unit, Hadassah Medical Center, Hebrew University of Jerusalem, Jerusalem 9103401, Israel; (H.P.); (F.K.)
| | - Yolanda Braun-Moscovici
- Shine Rheumatology Institute, Rambam Health Care Campus, Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa 3436212, Israel; (Y.B.-M.); (A.B.-G.)
| | - Alexandra Balbir-Gurman
- Shine Rheumatology Institute, Rambam Health Care Campus, Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa 3436212, Israel; (Y.B.-M.); (A.B.-G.)
| | - Daphna Paran
- Rheumatology Department, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6423906, Israel; (T.E.); (D.P.); (D.L.); (M.Z.); (O.E.); (I.K.); (A.B.); (A.P.); (S.P.); (S.N.); (O.E.)
| | - David Levartovsky
- Rheumatology Department, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6423906, Israel; (T.E.); (D.P.); (D.L.); (M.Z.); (O.E.); (I.K.); (A.B.); (A.P.); (S.P.); (S.N.); (O.E.)
| | - Michael Zisapel
- Rheumatology Department, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6423906, Israel; (T.E.); (D.P.); (D.L.); (M.Z.); (O.E.); (I.K.); (A.B.); (A.P.); (S.P.); (S.N.); (O.E.)
| | - Ofir Elalouf
- Rheumatology Department, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6423906, Israel; (T.E.); (D.P.); (D.L.); (M.Z.); (O.E.); (I.K.); (A.B.); (A.P.); (S.P.); (S.N.); (O.E.)
| | - Ilana Kaufman
- Rheumatology Department, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6423906, Israel; (T.E.); (D.P.); (D.L.); (M.Z.); (O.E.); (I.K.); (A.B.); (A.P.); (S.P.); (S.N.); (O.E.)
| | - Adi Broyde
- Rheumatology Department, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6423906, Israel; (T.E.); (D.P.); (D.L.); (M.Z.); (O.E.); (I.K.); (A.B.); (A.P.); (S.P.); (S.N.); (O.E.)
| | - Ari Polachek
- Rheumatology Department, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6423906, Israel; (T.E.); (D.P.); (D.L.); (M.Z.); (O.E.); (I.K.); (A.B.); (A.P.); (S.P.); (S.N.); (O.E.)
| | - Joy Feld
- Rheumatology Unit, Carmel Medical Center, Haifa 3436212, Israel; (D.Z.); (J.F.); (A.H.); (T.G.); (M.E.); (N.H.)
| | - Amir Haddad
- Rheumatology Unit, Carmel Medical Center, Haifa 3436212, Israel; (D.Z.); (J.F.); (A.H.); (T.G.); (M.E.); (N.H.)
| | - Tal Gazitt
- Rheumatology Unit, Carmel Medical Center, Haifa 3436212, Israel; (D.Z.); (J.F.); (A.H.); (T.G.); (M.E.); (N.H.)
| | - Muna Elias
- Rheumatology Unit, Carmel Medical Center, Haifa 3436212, Israel; (D.Z.); (J.F.); (A.H.); (T.G.); (M.E.); (N.H.)
| | - Nizar Higazi
- Rheumatology Unit, Carmel Medical Center, Haifa 3436212, Israel; (D.Z.); (J.F.); (A.H.); (T.G.); (M.E.); (N.H.)
| | - Fadi Kharouf
- Rheumatology Unit, Hadassah Medical Center, Hebrew University of Jerusalem, Jerusalem 9103401, Israel; (H.P.); (F.K.)
| | - Sara Pel
- Rheumatology Department, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6423906, Israel; (T.E.); (D.P.); (D.L.); (M.Z.); (O.E.); (I.K.); (A.B.); (A.P.); (S.P.); (S.N.); (O.E.)
| | - Sharon Nevo
- Rheumatology Department, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6423906, Israel; (T.E.); (D.P.); (D.L.); (M.Z.); (O.E.); (I.K.); (A.B.); (A.P.); (S.P.); (S.N.); (O.E.)
| | - Ori Elkayam
- Rheumatology Department, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6423906, Israel; (T.E.); (D.P.); (D.L.); (M.Z.); (O.E.); (I.K.); (A.B.); (A.P.); (S.P.); (S.N.); (O.E.)
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Heshin-Bekenstein M, Ziv A, Toplak N, Hagin D, Kadishevich D, Butbul Y, Saiag E, Shefer G, Sharon O, Pel S, Elkayam O, Uziel Y. POS0258 SAFETY AND IMMUNOGENICITY OF BNT162b2 mRNA COVID-19 VACCINE AMONG ADOLESCENTS WITH RHEUMATIC DISEASES TREATED WITH IMMUNOMODULATORY MEDICATIONS. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.4691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BackgroundAdolescents with juvenile-onset autoimmune inflammatory rheumatic diseases (AIIRD) could be at risk for disease flare secondary to SARS-CoV-2 infection or to withholding anti-inflammatory therapy. While vaccination can protect against COVID-19, safety and immunogenicity data regarding anti-SARS-CoV-2 vaccines among adolescents with AIIRD are limited.ObjectivesThis international, prospective, multicentre study evaluated the safety and immunogenicity of the BNT162b2 anti-SARS-CoV-2 vaccine among adolescents and young adults with juvenile-onset AIIRD, 80% of whom are on chronic immunomodulatory therapy.MethodsVaccine side effects, disease activity, and short-term efficacy were evaluated after 3 months in 91 patients. Anti-spike S1/S2 IgG antibody levels were evaluated in 37 patients and 22 controls, 2–9 weeks after the second dose.ResultsNinety-one patients and 40 healthy controls were included. Safety profile was good, with 96.7% (n=88) of patients reporting mild or no side-effects, and no change in disease activity. However, 3 patients had transient acute symptoms: 2 following the first vaccination (renal failure and pulmonary haemorrhage) and 1 following the second dose (mild lupus flare vs. viral infection). Seropositivity rate was 97.3% in the AIIRD group compared with 100% among controls. However, anti-S1/S2 antibody titres were significantly lower in the AIIRD group compared with controls (242±136.4 vs. 387.8±57.3 BAU/ml, respectively; p<0.0001). No cases of COVID-19 were documented during the 3-month follow-up.ConclusionVaccination of juvenile-onset AIIRD patients demonstrated good short-term safety and efficacy, high seropositivity rate, but lower anti-S1/S2 antibody titres compared to healthy controls. These results should encourage vaccination of adolescents with juvenile-onset AIIRD, even while on immunomodulation.References[1]Fact sheet for healthcare providers administrating vaccine emergency use authorization (EUA) of the Pfizer-BioNTech COVID-19 vaccine to prevent coronavirus disease 2019 (COVID-19) for 12 years of age and older dilute before use for 12 years of age and old; Available from: www.cvdvaccine.com.[2]Polack FP, Thomas SJ, Kitchin N, Absalon J, Gurtman A, Lockhart S, et al. Safety and efficacy of the BNT162b2 mRNA Covid-19 vaccine. N Eng J Med 2020;383:2603–15. DOI: 10.1056/NEJMoa2034577[3]Frenck RW, Klein NP, Kitchin N, Gurtman A, Absalon J, Lockhart S, et al. Safety, immunogenicity, and efficacy of the BNT162b2 Covid-19 vaccine in adolescents. N Eng J Med 2021;385:239–50.[4]First COVID-19 vaccine approved for children aged 12 to 15 in EU | European Medicines Agency [Internet]. [cited 2022 Jan 3]. Available from: https://www.ema.europa.eu/en/news/first-covid-19-vaccine-approved-children-aged-12-15-eu[5]FDA authorizes Pfizer-BioNTech COVID-19 vaccine for emergency use in children 5 through 11 Years of Age | FDA [Internet]. [cited 2022 Jan 1]. Available from: https://www.fda.gov/news-events/press-announcements/fda-authorizes-pfizer-biontech-covid-19-vaccine-emergency-use-children-5-through-11-years-age[6]Woodworth KR, Moulia D, Collins JP, Hadler SC, Jones JM, Reddy SC, et al. The Advisory Committee on Immunization Practices’ Interim Recommendation for Use of Pfizer-BioNTech COVID-19 Vaccine in Children Aged 5–11 Years — United States, November 2021. MMWR Morbidity and Mortality Weekly Report [Internet]. 2021 Nov 12 [cited 2021 Dec 1];70(45):1579–83. Available from: https://www.cdc.gov/mmwr/volumes/70/wr/mm7045e1.htm[7]Liguoro I, Pilotto C, Bonanni M, Ferrari ME, Pusiol A, Nocerino A, et al. SARS-COV-2 infection in children and newborns: a systematic review. Eur J Pediatr 2020;179:1029–46.AcknowledgementsWe thank the families and adolescents who participated in the study. We thank Mr. Yishai Friedlander, MPH, for performing the statistical analysis. We thank Faye Schreiber, MS, for editing the manuscript.Disclosure of InterestsNone declared
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Furer V, Eviatar T, Peleg H, Hagin D, Freund T, Levartovsky D, Paran D, Kaufman I, Broyde A, Polachek A, Elalouf O, Feld J, Haddad A, Gazitt T, Elias M, Hijaze N, Kharouf F, Gertel S, Nevo S, Pel S, Zisman D, Elkayam O. OP0177 IMMUNOGENICITY INDUCED BY TWO AND THREE DOSES OF THE BNT162B2 mRNA VACCINE IN PATIENTS WITH AUTOIMMUNE INFLAMMATORY RHEUMATIC DISEASES AND IMMUNOCOMPETENT CONTROLS: A LONGITUDINAL MULTI-CENTER STUDY. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.2074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BackgroundData on the kinetics of the immune response to SARS-CoV-2 vaccination in patients with autoimmune inflammatory rheumatic diseases (AIIRD) are limited.ObjectivesTo evaluate the kinetics of the immune response induced by two and three doses of the BNT162b2 mRNA vaccine in adult patients with AIIRD and immunocompetent controls.MethodsA prospective multicenter study investigated the antibody response to the BNT162b2 vaccine by serial measurement of serum anti-SARS-CoV-2 S1/S2 IgG titers at the following time points: 2-6 weeks (AIIRD n=720, controls n=122) and six months (AIIRD n=628, controls=116) after the second vaccine dose, and 2-6 weeks after the third vaccine dose (AIIRD n=169, controls n=45). A seropositive response was defined as a detectable anti-S1/S2 IgG titer ≥ 15 BAU/ml. T-cell immune response was evaluated in a sample of patients (n=28) and controls (n=9) by intracellular staining of S-stimulated CD4+ T-cells for TNFα and IFNγ production.ResultsThe two-dose vaccine regimen induced a higher humoral response in controls compared to patients, as reflected by the post-vaccination seropositivity rates of 100% vs 84.72%, p<0.0001, and 96.55% vs 74.26%, p<0.0001 at 2-to-6 weeks and at 6 months, respectively. The decline of S1/S2 IgG titers within six months was similar in controls and patients. Following the 3rd vaccine, the seropositivity rate increased to 80.47% and 100% in AIIRD and control groups, p=0.0028, with a significantly higher increase of S1/S2 IgG titers in controls compared with AIIRD patients, 284.09±76.58 vs 219.39±151.55 BAU/ml, p=0.0016. At all-time points, S1/S2 IgG titers were significantly lower in AIIRD patients compared with controls (Figure 1).We further investigated the impact of therapies on the vaccine‘s immunogenicity (Figure 1). Glucocorticoids (GC) were associated with a significantly lower seropositivity rate and lower S1/S2 IgG titers compared to controls at all time points. Monotherapy with methotrexate (MTX) was associated with a comparable to controls humoral response at all time points. Anti-cytokine biologics (TNFi, IL6i, IL17i) were associated with an initial high seropositivity rate, similar to controls, followed by a steeper decline at 6 months, 79.82% vs 96.55%, p=0.0001, and restoration of seropositivity after the 3rd vaccine dose in all patients. JAKi were associated with a mildly decreased seropositivity rate after the 2nd vaccine dose and similar to controls response after the 3rd vaccine dose. Abatacept was associated with a reduced immunogenicity after the 2nd vaccine dose, but was restored to 100% seropositivity after the 3rd vaccine dose. Rituximab (RTX) significantly blunted the humoral response at all time points, with a seropositivity rate of 42% after the 2nd vaccine dose, 29% at 6 months, and with increase to 40% after the 3rd vaccine dose. A third of the RTX-treated patients who were seronegative after two vaccine doses, seroconverted after the 3rd dose. The multivariate model for predicting the seropositive response to vaccination found that higher S1/S2 IgG titers after the 2nd vaccine dose was associated with a higher seropositivity rate following the 3rd vaccine dose, OR 1.026 (1.008-1.045), p=0.0027, and that treatment with RTX was associated with a 14.3-fold risk for a negative humoral response, p≤0.0001. Cellular immune response, evaluated mainly in RTX treated patients, was preserved prior to and after the 3rd vaccine dose and was similar to controls.ConclusionOver a six-month period, the two dose BNTb262 vaccination was associated with a similar extent of waning of the humoral immune response in AIIRD patients and controls. The 3rd vaccine dose restored the response in all controls and in patients treated with MTX monotherapy, anti-cytokine biologics, abatacept, and JAKi. Treatment with GC and RTX was associated with an impaired humoral response at all time points.AcknowledgementsWe would like to thank the statistician Mr Yishai Friedlander and Mr Yoram Neufeld for their valuable assistance.Disclosure of InterestsNone declared
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Elkayam O, Eviatar T, Peleg H, Paran D, Levartovsky D, Kaufman I, Broyde A, Elalouf O, Polachek A, Feld J, Haddad A, Gazitt T, Elias M, Hijaze N, Aassi M, Quebe-Fehling E, Alarcon I, Pel S, Zisman D, Furer V. POS1244 THE EFFECT OF SECUKINUMAB ON THE HUMORAL RESPONSE FOLLOWING TWO AND THREE DOSES OF THE BNT162b2 mRNA VACCINE IN PATIENTS WITH SPONDYLOARTHRITIS. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.3284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BackgroundData on the effect of secukinumab on the humoral response to the BNT162b2 mRNA vaccine are limited.ObjectivesWe aimed to assess prospectively the humoral response to the BNT162b2 mRNA vaccine in patients with spondyloarthritis (SpA) treated with secukinumab in comparison to immunocompetent controls.MethodsPatients with psoriatic arthritis (PsA) or ankylosing spondylitis (AS) treated with secukinumab for at least 3 months and immunocompetent controls were vaccinated with two-dose regimen of the BNT162b2 mRNA vaccine. Clinical and laboratory assessments were performed at 2-8 weeks [SpA: 37 on secukinumab, (median age 53% female), 122 controls (median age 53, 51% female)], and 6 months [SpA: 27 on secukinumab, 116 controls] after the second vaccine dose. A subgroup of patients (22 SpA on secukinumab, 45 controls) were evaluated after the third vaccine dose. The seropositive response was defined as a detectable S1/S2 IgG ≥15 binding antibody units (BAU)/ml.ResultsThe two-dose vaccine regimen induced a similar immunogenic response in patients and controls reflected by the seropositivity rates of 100% in both groups. After six months, the rate of seropositivity remained as high as 96% in both secukinumab-treated patients and immunocompetent controls. The decline of S1/S2 IgG titer within six months was similar in controls and secukinumab-treated patients, -66.4 (95% CI {-70.9, -39.9}) and -55 BAU/ml (95% CI {-95.42, -36.87)). Following the third vaccine, the seropositivity rate increased to 100 % in both groups. At all-time points, S1/S2 IgG titers were similar in secukinumab treated patients and immunocompetent controls (Figure 1).Figure 1.Kinetics of an immunogenic response (S1/S2 IgG titer) to two and three doses of the BNT162b2 mRNA vaccine in SpA patients treated with secukinumab and immunocompetent controls.ConclusionSpA patients treated with secukinumab consistently demonstrated an adequate humoral response to the BNT162b2 mRNA vaccination similar to immunocompetent controls, both short-term and within six months after two vaccine doses and after the third vaccine dose.AcknowledgementsWe would like to thank Mr Yishai Friedlander and Mr Yoram Neufeld for their assistance.Disclosure of InterestsOri Elkayam: None declared, Tali Eviatar: None declared, Hagit Peleg: None declared, Daphna Paran: None declared, David Levartovsky: None declared, Ilana Kaufman: None declared, Adi Broyde: None declared, Ofir Elalouf: None declared, Ari Polachek: None declared, Joy Feld: None declared, Amir Haddad: None declared, Tal Gazitt: None declared, Muna Elias: None declared, Nizar Hijaze: None declared, Maher Aassi Employee of: Novartis Pharma AG, Erhard Quebe-Fehling Employee of: Novartis Pharma AG, Ivette Alarcon Employee of: Novartis Pharma AG, Sara Pel: None declared, Devy Zisman: None declared, Victoria Furer: None declared
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Heshin-Bekenstein M, Ziv A, Toplak N, Hagin D, Kadishevich D, Butbul YA, Saiag E, Kaufman A, Shefer G, Sharon O, Pel S, Elkayam O, Uziel Y. Safety and immunogenicity of BNT162b2 mRNA COVID-19 vaccine in adolescents with rheumatic diseases treated with immunomodulatory medications. Rheumatology (Oxford) 2022; 61:4263-4272. [PMID: 35179569 PMCID: PMC9383463 DOI: 10.1093/rheumatology/keac103] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2022] [Revised: 02/06/2022] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES Adolescents with juvenile-onset autoimmune inflammatory rheumatic diseases (AIIRD) could be at-risk for disease flare secondary to SARS-CoV-2 infection or to withholding anti-inflammatory therapy. While vaccination can protect against COVID-19, safety and immunogenicity data regarding anti-SARS-CoV-2 vaccines among adolescents with AIIRD are limited. This international, prospective, multicentre study evaluated the safety and immunogenicity of the BNT162b2 anti-SARS-CoV-2 vaccine among adolescents and young adults with juvenile-onset AIIRD, 80% of whom are on chronic immunomodulatory therapy. METHODS Vaccine side effects, disease activity, and short-term efficacy were evaluated after 3 months in 91 patients. Anti-spike S1/S2 IgG antibody levels were evaluated in 37 patients and 22 controls, 2-9 weeks after the second dose. RESULTS Ninety-one patients and 40 healthy controls were included. Safety profile was good, with 96.7% (n = 88) of patients reporting mild or no side-effects, and no change in disease activity. However, 3 patients had transient acute symptoms: 2 following the first vaccination (renal failure and pulmonary haemorrhage) and 1 following the second dose (mild lupus flare vs viral infection). Seropositivity rate was 97.3% in the AIIRD group compared with 100% among controls. However, anti-S1/S2 antibody titres were significantly lower in the AIIRD group compared with controls (242 ± 136.4 vs 387.8 ± 57.3 BAU/ml, respectively; p< 0.0001). No cases of COVID-19 were documented during the 3-month follow-up. CONCLUSION Vaccination of juvenile-onset AIIRD patients demonstrated good short-term safety and efficacy, high seropositivity rate, but lower anti-S1/S2 antibody titres compared with healthy controls. These results should encourage vaccination of adolescents with juvenile-onset AIIRD, even while on immunomodulation.
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Affiliation(s)
- Merav Heshin-Bekenstein
- Pediatric Rheumatology Service, Dana-Dwek Children's Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Amit Ziv
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Pediatric Rheumatology Unit, Meir Medical Center, Kfar Saba, Israel
| | - Natasa Toplak
- Department of Allergology, Rheumatology and Clinical Immunology, University Children's Hospital, University Medical Center Ljubljana, Ljubljana, Slovenia.,Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - David Hagin
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Allergy and Clinical Immunology Unit, Department of Medicine, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | | | - Yonatan A Butbul
- Pediatric Rheumatology Unit, Rambam Medical Center, Haifa, Israel
| | - Esther Saiag
- Hospital Management, Information and Operation Branch, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Alla Kaufman
- Pediatric Department, Dana-Dwek Children's Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Gabi Shefer
- Department of Endocrinology Metabolism and Hypertension, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Orli Sharon
- Department of Endocrinology Metabolism and Hypertension, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Sara Pel
- Rheumatology Department, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Ori Elkayam
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Rheumatology Department, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Yosef Uziel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Pediatric Rheumatology Unit, Meir Medical Center, Kfar Saba, Israel
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Gertel S, Polachek A, Furer V, Levartovsky D, Sidis H, Pel S, Paran D, Elkayam O. T cell functions of psoriatic arthritis patients are regulated differently by TNF, IL-17A and IL-6 receptor blockades in vitro. Clin Exp Rheumatol 2022; 40:120-128. [DOI: 10.55563/clinexprheumatol/jdhe41] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Accepted: 01/25/2021] [Indexed: 11/13/2022]
Affiliation(s)
- Smadar Gertel
- Department of Rheumatology, Tel Aviv Sourasky Medical Center, affiliated to the Sackler Faculty of Medicine, Tel-Aviv University, Israel.
| | - Ari Polachek
- Department of Rheumatology, Tel Aviv Sourasky Medical Center, affiliated to the Sackler Faculty of Medicine, Tel-Aviv University, Israel
| | - Victoria Furer
- Department of Rheumatology, Tel Aviv Sourasky Medical Center, affiliated to the Sackler Faculty of Medicine, Tel-Aviv University, Israel
| | - David Levartovsky
- Department of Rheumatology, Tel Aviv Sourasky Medical Center, affiliated to the Sackler Faculty of Medicine, Tel-Aviv University, Israel
| | - Haya Sidis
- Department of Rheumatology, Tel Aviv Sourasky Medical Center, affiliated to the Sackler Faculty of Medicine, Tel-Aviv University, Israel
| | - Sara Pel
- Department of Rheumatology, Tel Aviv Sourasky Medical Center, affiliated to the Sackler Faculty of Medicine, Tel-Aviv University, Israel
| | - Daphna Paran
- Department of Rheumatology, Tel Aviv Sourasky Medical Center, affiliated to the Sackler Faculty of Medicine, Tel-Aviv University, Israel
| | - Ori Elkayam
- Department of Rheumatology, Tel Aviv Sourasky Medical Center, affiliated to the Sackler Faculty of Medicine, Tel-Aviv University, Israel
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Furer V, Eviatar T, Zisman D, Peleg H, Paran D, Levartovsky D, Zisapel M, Elalouf O, Kaufman I, Meidan R, Broyde A, Polachek A, Wollman J, Litinsky I, Meridor K, Nochomovitz H, Silberman A, Rosenberg D, Feld J, Haddad A, Gazzit T, Elias M, Higazi N, Kharouf F, Shefer G, Sharon O, Pel S, Nevo S, Elkayam O. Immunogenicity and safety of the BNT162b2 mRNA COVID-19 vaccine in adult patients with autoimmune inflammatory rheumatic diseases and in the general population: a multicentre study. Ann Rheum Dis 2021; 80:1330-1338. [PMID: 34127481 PMCID: PMC8206170 DOI: 10.1136/annrheumdis-2021-220647] [Citation(s) in RCA: 434] [Impact Index Per Article: 144.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Accepted: 05/27/2021] [Indexed: 12/28/2022]
Abstract
INTRODUCTION Vaccination represents a cornerstone in mastering the COVID-19 pandemic. Data on immunogenicity and safety of messenger RNA (mRNA) vaccines in patients with autoimmune inflammatory rheumatic diseases (AIIRD) are limited. METHODS A multicentre observational study evaluated the immunogenicity and safety of the two-dose regimen BNT162b2 mRNA vaccine in adult patients with AIIRD (n=686) compared with the general population (n=121). Serum IgG antibody levels against SARS-CoV-2 spike S1/S2 proteins were measured 2-6 weeks after the second vaccine dose. Seropositivity was defined as IgG ≥15 binding antibody units (BAU)/mL. Vaccination efficacy, safety, and disease activity were assessed within 6 weeks after the second vaccine dose. RESULTS Following vaccination, the seropositivity rate and S1/S2 IgG levels were significantly lower among patients with AIIRD versus controls (86% (n=590) vs 100%, p<0.0001 and 132.9±91.7 vs 218.6±82.06 BAU/mL, p<0.0001, respectively). Risk factors for reduced immunogenicity included older age and treatment with glucocorticoids, rituximab, mycophenolate mofetil (MMF), and abatacept. Rituximab was the main cause of a seronegative response (39% seropositivity). There were no postvaccination symptomatic cases of COVID-19 among patients with AIIRD and one mild case in the control group. Major adverse events in patients with AIIRD included death (n=2) several weeks after the second vaccine dose, non-disseminated herpes zoster (n=6), uveitis (n=2), and pericarditis (n=1). Postvaccination disease activity remained stable in the majority of patients. CONCLUSION mRNA BNTb262 vaccine was immunogenic in the majority of patients with AIIRD, with an acceptable safety profile. Treatment with glucocorticoids, rituximab, MMF, and abatacept was associated with a significantly reduced BNT162b2-induced immunogenicity.
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Affiliation(s)
- Victoria Furer
- Rheumatology Department, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Tel Aviv University Sackler Faculty of Medicine, Tel Aviv, Israel
| | - Tali Eviatar
- Rheumatology Department, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Tel Aviv University Sackler Faculty of Medicine, Tel Aviv, Israel
| | - Devy Zisman
- Rheumatology Unit, Carmel Hospital, Haifa, Israel
- Medicine, Technion Israel Institute of Technology, Haifa, Israel
| | - Hagit Peleg
- Rheumatology Unit, Hadassah University Hospital, Jerusalem, Israel
| | - Daphna Paran
- Rheumatology Department, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Tel Aviv University Sackler Faculty of Medicine, Tel Aviv, Israel
| | - David Levartovsky
- Rheumatology Department, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Michael Zisapel
- Rheumatology Department, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Ofir Elalouf
- Rheumatology Department, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Tel Aviv University Sackler Faculty of Medicine, Tel Aviv, Israel
| | - Ilana Kaufman
- Rheumatology Department, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Tel Aviv University Sackler Faculty of Medicine, Tel Aviv, Israel
| | - Roni Meidan
- Tel Aviv University Sackler Faculty of Medicine, Tel Aviv, Israel
- Internal Medicine, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Adi Broyde
- Rheumatology Department, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Tel Aviv University Sackler Faculty of Medicine, Tel Aviv, Israel
| | - Ari Polachek
- Rheumatology Department, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Tel Aviv University Sackler Faculty of Medicine, Tel Aviv, Israel
| | - Jonathan Wollman
- Rheumatology Department, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Tel Aviv University Sackler Faculty of Medicine, Tel Aviv, Israel
| | - Ira Litinsky
- Rheumatology Department, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Tel Aviv University Sackler Faculty of Medicine, Tel Aviv, Israel
| | - Katya Meridor
- Rheumatology Department, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Tel Aviv University Sackler Faculty of Medicine, Tel Aviv, Israel
| | - Hila Nochomovitz
- Rheumatology Department, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Tel Aviv University Sackler Faculty of Medicine, Tel Aviv, Israel
| | - Adi Silberman
- Rheumatology Department, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Tel Aviv University Sackler Faculty of Medicine, Tel Aviv, Israel
| | - Dana Rosenberg
- Rheumatology Department, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Tel Aviv University Sackler Faculty of Medicine, Tel Aviv, Israel
| | - Joy Feld
- Rheumatology Unit, Carmel Hospital, Haifa, Israel
| | - Amir Haddad
- Rheumatology Unit, Carmel Hospital, Haifa, Israel
| | - Tal Gazzit
- Rheumatology Unit, Carmel Hospital, Haifa, Israel
| | - Muna Elias
- Rheumatology Unit, Carmel Hospital, Haifa, Israel
| | - Nizar Higazi
- Rheumatology Unit, Carmel Hospital, Haifa, Israel
| | - Fadi Kharouf
- Rheumatology Unit, Hadassah University Hospital, Jerusalem, Israel
- The Hebrew University of Jerusalem Faculty of Medicine, Jerusalem, Jerusalem, Israel
| | - Gabi Shefer
- Endocrinology Department, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Orly Sharon
- Endocrinology Department, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Sara Pel
- Rheumatology Department, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Sharon Nevo
- Rheumatology Department, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Ori Elkayam
- Rheumatology Department, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Tel Aviv University Sackler Faculty of Medicine, Tel Aviv, Israel
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Eviatar T, Levartovsky D, Furer V, Polachek A, Elalouf O, Zisapel M, Halperin T, Turner D, Paran D, Pel S, Nevo S, Elkayam O. POS1206 SEROPREVALENCE OF SARS-CoV-2 ANTIBODIES IN AUTOIMMUNE INFLAMMATORY RHEUMATOLOGIC PATIENTS. Ann Rheum Dis 2021. [DOI: 10.1136/annrheumdis-2021-eular.2107] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background:Immune responses in AIIRD patients may be reduced and influenced by immunosuppressive treatments[1].The effect of immunosuppression on the mounting of SARS-CoV-2 antibodies in AIIRD is not clear.Objectives:To assess the prevalence of SARS-CoV-2 antibodies in AIIRD patients and to define clinical factors affecting this prevalence.Methods:Consecutive consenting AIIRD patients from the Rheumatologic department in Tel Aviv Medical Center participated in the study.Patients answered a questionnaire and were tested for SARS-CoV-2 antibodies. A two stage antibody testing was done in order to increase specificity.Results:The study included 560 AIIRD patients (229 RA, 149 PsA, 84 SLE, 55 vasculitidies, 40 SpA, 3 other CTD), of them 26 patients were found to have SARS-CoV-2 IgG antibodies (4.6%) (Table 1). This was more than double than a previous prevalence in the same clinic population studied after the first wave of the pandemic in Israel, which was 2.07% (accepted for publication).A lower rate of immunosuppression was found for positive SARS-CoV-2 IgG patients compared to negative serology patients (Table 1, p=0.009). There was also a trend for the subgroup of patients on biologic DMARDS (26.92% vs. 47% respectively, p=0.06).Positive SARS-CoV-2 PCR test was reported and confirmed in 36 patients, of them 14 (38.89%) had negative serology. Patients who did not have antibodies had numerically more than double rates of glucocorticoids and bDMARDs treatment. The time between positive PCR test to positive serology test was significantly shorter (mean±standart deviation 75.57±40.44 days) than the time between positive PCR to negative serology test (130.79±86.47 (p=0.04) (Table 1 and Figure 1) suggesting a fading of the antibody response with time.Conclusion:The prevalence of SARS-CoV-2 IgG was 4.6% in a population of AIIRD patients from a single tertiary medical center in Israel. SARS-CoV-2 seroprevalence tended to be low among AIIRD patients on immunosuppressive treatment, including in patients with a confirmed history of positive SARS-CoV-2 PCR, similar to other studies [3].As in individuals without AIIRD, the mounting of SARS-CoV-2 IgG seems to fade with time.Larger studies are needed to confirm the potential effect of immunosuppression on the antibody response in AIIRDs.Table 1.Demographic and clinical characteristics of patients with negative and positive SARS-CoV-2 IgG, and in the subgroup with positive SARS-CoV-2 PCR testTotal population (n=560)Positive PCR population (n=36)Negative IgG(n=534)Positive IgG(n=26)PNegative IgG(n=14)Positive IgG(n=22)PFemale n (%)360 (67.42)22 (84.62)0.0810 (71.43)18 (81.82)0.68Age median (95% CI)57 (54.95-57.58)52.5 (46.55-58.6)0.2342 (35.46-53.11)52.5 (47.62-60.65)0.06No. of comorbiditiesmean±STD (95%CI)0.88±1.15 (0.78-0.98)0.92±1.2 (0.44-1.41)0.860.79±1.12 (0.14-1.43)0.96±1.3 (0.4-1.51)0.68AIIRD treatments n(%)Total immunosuppression401 (75.09)13 (50)0.00911 (78.57)12 (54.54)0.175GC113 (21.16)3 (11.54)0.325 (35.71)3 (13.64)0.32csDMARDS257 (48.13)13 (50)17 (50)13 (59.09)0.73bDMARDS251 (47)7 (26.92)0.069 (64.29)7 (31.82)0.09Anti CD-2036 (6.74)00.41 (7.14)00.39SARS-CoV-2, severe acute respiratory syndrome-coronavirus-2; IgG, immunoglobulin G; PCR, polymerase chain reaction; n, number; 95%CI, 95% confidence interval; GC, glucocorticoids; csDMARDS, conventional synthetic disease modifying antirheumatic drugs; bDMARDS, biologic disease modifying antirheumatic drugs.References:[1]V. Furer et al., “Incidence and prevalence of vaccine preventable infections in adult patients with autoimmune inflammatory rheumatic diseases (AIIRD): a systemic literature review informing the 2019 update of the EULAR recommendations for vaccination in adult patients wit,” RMD Open, vol. 5, no. 2, p. e001041, Sep. 2019.[2]D. Simon et al., “Patients with immune-mediated inflammatory diseases receiving cytokine inhibitors have low prevalence of SARS-CoV-2 seroconversion,” Nat. Commun., vol. 11, no. 1, pp. 1–7, 2020.Acknowledgements:This study was performed in collaboration with the Israeli Ministry of Health.Disclosure of Interests:None declared.
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Eviatar T, Furer V, Polachek A, Levartovsky D, Elalouf O, Zisapel M, Halperin T, Turner D, Paran D, Pel S, Nevo S, Elkayam O. Seroprevalence of SARS-CoV-2 antibodies in patients with autoimmune inflammatory rheumatic diseases. Clin Exp Rheumatol 2021; 40:1299-1305. [DOI: 10.55563/clinexprheumatol/ykin5p] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Accepted: 07/05/2021] [Indexed: 11/13/2022]
Affiliation(s)
- Tali Eviatar
- Rheumatology Department, Tel Aviv Sourasky Medical Center, and Sackler Faculty of Medicine, Tel Aviv University, Israel. ,
| | - Victoria Furer
- Rheumatology Department, Tel Aviv Sourasky Medical Center, and Sackler Faculty of Medicine, Tel Aviv University, Israel
| | - Ari Polachek
- Rheumatology Department, Tel Aviv Sourasky Medical Center, and Sackler Faculty of Medicine, Tel Aviv University, Israel
| | - David Levartovsky
- Rheumatology Department, Tel Aviv Sourasky Medical Center, and Sackler Faculty of Medicine, Tel Aviv University, Usrael
| | - Ofir Elalouf
- Rheumatology Department, Tel Aviv Sourasky Medical Center, and Sackler Faculty of Medicine, Tel Aviv University, Israel
| | - Michael Zisapel
- Rheumatology Department, Tel Aviv Sourasky Medical Center, and Sackler Faculty of Medicine, Tel Aviv University, Israel
| | - Tami Halperin
- Immunology Laboratory, Tel Aviv Sourasky Medical Center, and Sackler Faculty of Medicine, Tel Aviv University, Israel
| | - Dan Turner
- Infectious Diseases Unit, Tel Aviv Sourasky Medical Center, and Sackler Faculty of Medicine, Tel Aviv University, Israel
| | - Daphna Paran
- Rheumatology Department, Tel Aviv Sourasky Medical Center, and Sackler Faculty of Medicine, Tel Aviv University, Israel
| | - Sara Pel
- Rheumatology Department, Tel Aviv Sourasky Medical Center, and Sackler Faculty of Medicine, Tel Aviv University, Israel
| | - Sharon Nevo
- Rheumatology Department, Tel Aviv Sourasky Medical Center, and Sackler Faculty of Medicine, Tel Aviv University, Israel
| | - Ori Elkayam
- Rheumatology Department, Tel Aviv Sourasky Medical Center, and Sackler Faculty of Medicine, Tel Aviv University, Israel
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Furer V, Eviatar T, Zisman D, Peleg H, Paran D, Levartovsky D, Zisapel M, Elalouf O, Kaufman I, Meidan R, Broyde A, Polachek A, Wollman J, Litinsky I, Meridor K, Nochomovitz H, Silberman A, Rosenberg D, Feld J, Haddad A, Gazitt T, Elias M, Higazi N, Kharouf F, Shefer G, Sharon O, Pel S, Nevo S, Elkayam O. LB0003 IMMUNOGENICITY AND SAFETY OF THE BNT162b2 mRNA COVID-19 VACCINE IN ADULT PATIENTS WITH AUTOIMMUNE INFLAMMATORY RHEUMATIC DISEASES AND GENERAL POPULATION: A MULTICENTER STUDY. Ann Rheum Dis 2021. [DOI: 10.1136/annrheumdis-2021-eular.5096] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background:Vaccination represents a cornerstone in mastering the COVID-19 pandemic. Data on immunogenicity, efficacy, and safety of the novel BNT162b2 mRNA vaccine in patients with autoimmune inflammatory rheumatic diseases (AIIRD) are limited.Objectives:To investigate the immunogenicity, efficacy, and safety of the BNT162b2 mRNA vaccine in patients with AIIRD compared to the general population.Methods:A prospective multicenter study investigated immunogenicity, efficacy, and safety of the two-dose regimen BNT162b2 mRNA vaccine in adult patients with AIIRD including rheumatoid arthritis (RA), psoriatic arthritis (PsA), axial spondyloarthropathy (axSpA), systemic lupus erythematosus (SLE), connective tissues diseases (CTD), systemic vasculitides, and idiopathic inflammatory myositis (IIM), compared to control subjects without rheumatic diseases or immunosuppressive therapies. Serum IgG antibody levels against SARS-CoV-2 spike S1/S2 proteins were measured 2 - 6 weeks after the second vaccine dose. Seropositivity was defined as IgG ≥15 binding antibody units (BAU)/ml. Post-vaccination efficacy defined as post-vaccination COVID-19 infection and safety were assessed. Pre- and post- vaccination disease activity indices were assessed as appropriate for each disease.Results:A total of 686 AIIRD patients and 121 controls participated into the study. AIIRD patients were significantly older than controls, mean age±SD 56.76±14.88 vs 50.76±14.68, respectively, p<0.0001. A total of 95.2% (n=653) AIIRD patients were treated with immunomodulatory medications.The seropositivity rate was 86% (n=590) in patients with AIIRD compared to 100% in controls (p <0.0001) The level of the S1/S2 antibodies was significantly reduced in AIIRD patients compared to controls (mean± SD 132.9±91.7 vs 218.6±82.06, P<0.0001). In patients with PsA, AxSpA, SLE, and LVV, the seropositive rate was above 90%. In RA, the seropositive rate was 82.1% and the lowest seropositive rate (<40%) was observed in patients with AAV and IIM.Anti-CD20 significantly impaired the vaccine’s immunogenicity, with the lowest seropositivity rate of 39%. The use of GC, mycophenolate mofetil (MMF), and abatacept was associated with a significantly lower rate of seropositivity (Figure 1). MTX significantly reduced the seropositivity in patients treated with MTX monotherapy and in combinations with other treatments (92% and 84%, respectively), although at a lesser magnitude than anti-CD20, MMF, and abatacept. More than 97% of patients treated with anti-cytokine therapies including TNFi, interleukin-17 and interleukin-6 inhibitors had an appropriate immunogenic response when used as monotherapy. The combination of TNFi with MTX significantly reduced the rate of seropositivity to 93%, p=0.04. Age over 65 years, a diagnosis of RA, IIM, ANCA-associated vascilitis, and treatment with GC, MMF, anti-CD20, and abatacept were associated with a reduced likelihood of seropositivity.Figure 1.Seropositivity rate by immunosuppressive treatment.There were no post-vaccination symptomatic cases of COVID-19 among AIIRD patients and one mild case in the control group. Major adverse events in AIIRD patients included death (n=2) several weeks after the second vaccine dose, non-disseminated herpes zoster (n=6), uveitis (n=2), and pericarditis (n=1). Post-vaccination disease activity remained stable in the majority of patients.Conclusion:Vaccination with the BNTb262 vaccine resulted in an adequate immunogenic response with an acceptable safety profile in the majority of patients with AIIRD. Treatment with GC, rituximab, MMF, and abatacept may impair BNT162b2-induced immunogenicity. Postponing administration of rituximab, when clinically feasible, seems to be reasonable to improve vaccine-induced immunogenicity. Holding treatment with abatacept and MMF may be considered on an individual basis.Disclosure of Interests:None declared
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Eviatar T, Elalouf O, Furer V, Goldstein-Lahat Y, Paran Y, Pel S, Nevo S, Zisapel M, Alcalay Y, Elkayam O. Prevalence of COVID-19 and seroprevalence to SARS-CoV-2 in a rheumatologic patient population from a tertiary referral clinic in Israel. Intern Med J 2021; 51:682-690. [PMID: 33844415 PMCID: PMC8251200 DOI: 10.1111/imj.15202] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Revised: 12/05/2020] [Accepted: 01/04/2021] [Indexed: 01/19/2023]
Abstract
Background It is unclear if the prevalence of COVID‐19 in rheumatologic patients is similar to that of the general population. There are no reports of seroprevalence of SARS‐CoV‐2 in these patients. Aims To investigate prevalence of COVID‐19 cases and seroprevalence among rheumatologic patients and the risk factors for infection. Methods A cross‐sectional study in a rheumatologic population. An online questionnaire was sent on 31 April 2020. Blood samples from 20% sample of patients were drawn for SARS‐CoV‐2 antibodies. Patients were divided based on autoimmune (AI) diagnosis. Prevalence of COVID‐19 by nasopharyngeal swab and by serology (seroprevalence) was compared to national data. Risk factors for infection of SARS‐CoV‐2 were assessed. Results The study group included 1204 patients, 74.5% had an AI diagnosis. The prevalence of COVID‐19 was 0.16% in the rheumatologic patient population and 0.22% in the AI group, which was not different from prevalence in Israel on 4 May 2020 (0.18%, P = 0.912 and P = 0.759 respectively). Serologic tests were performed in 242 patients, of which five were found positive pointing to a seroprevalence of 2.07%. Exposure to a known COVID‐19 patient was the only significant risk factor for being positive by swab or by serology. AI diagnosis, immunosuppression, corticosteroid, hydroxychloroquine did not influence the risk. Conclusions The prevalence of COVID‐19 in a population of rheumatologic patients was similar to that of the general population. Mild/asymptomatic cases may be prevalent according to serologic tests. The major risk factor for infection is exposure to a known case of COVID‐19, and immunosuppression did not play a role in the risk of infection.
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Affiliation(s)
- Tali Eviatar
- Rheumatology Department, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ofir Elalouf
- Rheumatology Department, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Victoria Furer
- Rheumatology Department, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yael Goldstein-Lahat
- Rheumatology Department, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yael Paran
- Infectious Disease Unit, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Sara Pel
- Rheumatology Department, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Sharon Nevo
- Rheumatology Department, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Michael Zisapel
- Rheumatology Department, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yifat Alcalay
- Immunology Laboratory, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ori Elkayam
- Rheumatology Department, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Jacobs AAC, Harks F, Pauwels R, Cao Q, Holtslag H, Pel S, Segers RPAM. Efficacy of a novel intradermal Lawsonia intracellularis vaccine in pigs against experimental infection and under field conditions. Porcine Health Manag 2020; 6:25. [PMID: 33014411 PMCID: PMC7528468 DOI: 10.1186/s40813-020-00164-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Accepted: 08/07/2020] [Indexed: 11/10/2022] Open
Abstract
Background The efficacy of a novel inactivated intradermal Lawsonia intracellularis vaccine, Porcilis® Lawsonia ID, was evaluated in two experimental vaccination-challenge studies and under field conditions on a farm with a history of recurrent acute ileitis. In addition, the efficacy of the vaccine was compared to that of a commercially available live attenuated vaccine. The novel inactivated vaccine consists of a freeze-dried antigen fraction that is dissolved just prior to use in either the adjuvant or in Porcilis® PCV ID; an existing intradermal vaccine against porcine Circovirus type 2. In the two experimental vaccination-challenge studies, groups of 25 piglets were vaccinated once at 3 weeks of age or left unvaccinated as challenge control. Vaccines tested were Porcilis® Lawsonia ID as standalone (study 1) or in associated mixed use with Porcilis® PCV ID (study 2) and an orally administered commercially available live vaccine (study 1). The pigs were challenged with virulent L. intracellularis at 4 weeks (study 1) or 21 weeks (study 2) after vaccination. Post-challenge, the pigs were evaluated for clinical signs, average daily weight gain, shedding and macroscopic as well as microscopic immuno-histological ileum lesion scores. In the field study, the mortality and key performance parameters were evaluated over a period of 8 months. Results The results of the two experimental vaccination-challenge studies showed that Porcilis® Lawsonia ID as single vaccine or in associated mixed use with Porcilis® PCV ID, induced statistically significant protection against experimental L. intracellularis infection, 4 weeks or 21 weeks after vaccination. This was demonstrated by lower clinical scores, improved weight gain, reduction of L. intracellularis shedding and reduction of macroscopic as well as microscopic ileum lesion scores when compared to the controls. The protection induced was superior to that of the commercially available live vaccine. In the field study Porcilis® Lawsonia ID was highly efficacious in reducing L. intracellularis associated mortality and improving key production parameters. Conclusion The results support that this new intradermal vaccine is efficacious against L. intracellularis and may be used in associated mixed use with Porcilis® PCV ID.
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Affiliation(s)
- A A C Jacobs
- MSD Animal Health, Wim de Körverstraat 35, PO Box 31, 5830AA Boxmeer, The Netherlands
| | - F Harks
- MSD Animal Health, Wim de Körverstraat 35, PO Box 31, 5830AA Boxmeer, The Netherlands
| | - R Pauwels
- MSD Animal Health, Wim de Körverstraat 35, PO Box 31, 5830AA Boxmeer, The Netherlands
| | - Q Cao
- MSD Animal Health, Wim de Körverstraat 35, PO Box 31, 5830AA Boxmeer, The Netherlands
| | - H Holtslag
- MSD Animal Health, Wim de Körverstraat 35, PO Box 31, 5830AA Boxmeer, The Netherlands
| | - S Pel
- MSD Animal Health, Wim de Körverstraat 35, PO Box 31, 5830AA Boxmeer, The Netherlands
| | - R P A M Segers
- MSD Animal Health, Wim de Körverstraat 35, PO Box 31, 5830AA Boxmeer, The Netherlands
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Jacobs AAC, Harks F, Hazenberg L, Hoeijmakers MJH, Nell T, Pel S, Segers RPAM. Efficacy of a novel inactivated Lawsonia intracellularis vaccine in pigs against experimental infection and under field conditions. Vaccine 2019; 37:2149-2157. [PMID: 30867100 DOI: 10.1016/j.vaccine.2019.02.067] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Revised: 02/13/2019] [Accepted: 02/15/2019] [Indexed: 10/27/2022]
Abstract
The efficacy of a novel inactivated Lawsonia intracellularis vaccine, Porcilis® Lawsonia, was compared to that of a commercially available live attenuated vaccine in three experimental vaccination-challenge studies in pigs. The efficacy of the new vaccine was further tested under field conditions on a farm with a history of acute ileitis. The novel inactivated vaccine consists of a freeze-dried antigen fraction that is dissolved just prior to use in either the adjuvant or in Porcilis® PCV M Hyo; an existing combination vaccine against porcine circovirus type 2 and Mycoplasma hyopneumoniae. The three experimental vaccination-challenge trials had a similar design and for each trial 75 piglets were used, randomly allotted to three groups of 25 piglets. The pigs were vaccinated at 4 or 5 weeks of age with either Porcilis® Lawsonia in adjuvant or in associated mixed use with Porcilis® PCV M Hyo (group 1), with the live vaccine (group 2), or left as unvaccinated controls (group 3). The pigs were challenged with virulent Lawsonia intracellularis 3, 4 or 17 weeks after vaccination. Post-challenge the pigs were evaluated for clinical signs, average daily weight gain, shedding and macroscopic as well as microscopic immuno-histological ileum lesion scores. In the field study, the mortality and key performance parameters were evaluated over a period of 8 months. The results of all three experimental vaccination-challenge trials showed that Porcilis® Lawsonia induced statistically significant protection against experimental Lawsonia intracellularis infection. This was demonstrated by lower clinical scores, improved weight gain, reduction of Lawsonia intracellularis shedding and reduction of macroscopic as well as microscopic ileum lesion scores when compared to the controls. The protection induced was superior to that of the commercially available live vaccine. In the field study, Porcilis® Lawsonia proved to be highly efficacious; reducing Lawsonia associated mortality to zero and improving key production parameters.
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Affiliation(s)
- A A C Jacobs
- MSD Animal Health, PO Box 31, 5830 AA Boxmeer, the Netherlands.
| | - F Harks
- MSD Animal Health, PO Box 31, 5830 AA Boxmeer, the Netherlands.
| | - L Hazenberg
- MSD Animal Health, PO Box 31, 5830 AA Boxmeer, the Netherlands.
| | | | - T Nell
- MSD Animal Health, PO Box 31, 5830 AA Boxmeer, the Netherlands.
| | - S Pel
- MSD Animal Health, PO Box 31, 5830 AA Boxmeer, the Netherlands.
| | - R P A M Segers
- MSD Animal Health, PO Box 31, 5830 AA Boxmeer, the Netherlands.
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Paran D, Smith Y, Pundak S, Arad U, Levartovsky D, Kaufman I, Wollman J, Furer V, Broyde A, Elalouf O, Caspi D, Pel S, Elkayam O. Expression levels of selected genes can predict individual rheumatoid arthritis patient response to tumor necrosis factor alpha blocker treatment. Curr Med Res Opin 2018; 34:1777-1783. [PMID: 29569514 DOI: 10.1080/03007995.2018.1443581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
OBJECTIVES Rheumatoid arthritis (RA) patients have many therapeutic options; however, tools to predict individual patient response are limited. The Genefron personal diagnostic kit, developed by analyzing large datasets, utilizes selected interferon stimulated gene expressions to predict treatment response. This study evaluates the kit's prediction accuracy of individual RA patients' response to tumor necrosis alpha (TNFα) blockers. METHODS A retrospective analysis was performed on RA patients reported in published datasets. A prospective analysis assessed RA patients, before and 3 months after starting a TNFα blocker. Clinical response was evaluated according to EULAR response criteria. Blood samples were obtained before starting treatment and were analyzed utilizing the kit which measures expression levels of selected genes by quantitative real time polymerase chain reaction (PCR). ROC analysis was applied to the published datasets and the prospective data. RESULTS The Genefron kit analysis of retrospective data predicted the response to a TNFα blocker in 53 of 61 RA patients (86.8% accuracy). In the prospective analysis, the kit predicted the response in 16 of 18 patients (89% accuracy) achieving a EULAR moderate response, and in 15 of 18 patients achieving a EULAR good response (83.3% accuracy). ROC analysis applied to the two published datasets yielded an AUC of 0.89. ROC analysis applied to the prospective data yielded an AUC of 0.83 (sensitivity - 100%, specificity - 75%) The statistical power obtained in the prospective study was .9. CONCLUSION The diagnostic kit predicted the response to TNFα blockers in a high percentage of patients assessed retrospectively or prospectively. This personal kit may guide selection of a suitable biological drug for the individual RA patient.
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Affiliation(s)
- Daphna Paran
- a Rheumatology Department, Tel-Aviv Medical Center and the Sackler School of Medicine , Tel-Aviv University , Israel
| | - Yoav Smith
- b Genomic Data Analysis Hadassah Medical School Hebrew University , Jerusalem , Israel
| | | | - Uri Arad
- a Rheumatology Department, Tel-Aviv Medical Center and the Sackler School of Medicine , Tel-Aviv University , Israel
| | - David Levartovsky
- a Rheumatology Department, Tel-Aviv Medical Center and the Sackler School of Medicine , Tel-Aviv University , Israel
| | - Ilana Kaufman
- a Rheumatology Department, Tel-Aviv Medical Center and the Sackler School of Medicine , Tel-Aviv University , Israel
| | - Jonathan Wollman
- a Rheumatology Department, Tel-Aviv Medical Center and the Sackler School of Medicine , Tel-Aviv University , Israel
| | - Victoria Furer
- a Rheumatology Department, Tel-Aviv Medical Center and the Sackler School of Medicine , Tel-Aviv University , Israel
| | - Adi Broyde
- a Rheumatology Department, Tel-Aviv Medical Center and the Sackler School of Medicine , Tel-Aviv University , Israel
| | - Ofir Elalouf
- a Rheumatology Department, Tel-Aviv Medical Center and the Sackler School of Medicine , Tel-Aviv University , Israel
| | - Dan Caspi
- a Rheumatology Department, Tel-Aviv Medical Center and the Sackler School of Medicine , Tel-Aviv University , Israel
| | - Sara Pel
- a Rheumatology Department, Tel-Aviv Medical Center and the Sackler School of Medicine , Tel-Aviv University , Israel
| | - Ori Elkayam
- a Rheumatology Department, Tel-Aviv Medical Center and the Sackler School of Medicine , Tel-Aviv University , Israel
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Sno M, Cox E, Holtslag H, Nell T, Pel S, Segers R, Fachinger V, Witvliet M. Efficacy and safety of a new intradermal PCV2 vaccine in pigs. ACTA ACUST UNITED AC 2016. [DOI: 10.1016/j.trivac.2016.01.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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Brazowski E, Rozen P, Pel S, Samuel Z, Solar I, Rosner G. Can a gastrointestinal pathologist identify microsatellite instability in colorectal cancer with reproducibility and a high degree of specificity? Fam Cancer 2012; 11:249-57. [DOI: 10.1007/s10689-012-9508-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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Rozen P, Liphshitz I, Rosner G, Barchana M, Lachter J, Pel S, Shohat T, Santo E. Pancreatic cancer in Israel: the epidemiology, possibilities of prevention, early detection and screening. Isr Med Assoc J 2009; 11:710-713. [PMID: 20166335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Pancreatic cancer is not a common malignancy in Israel, but it is the third most common cause of cancer mortality, attributable to a lack of screening tests, inaccessibility of the pancreas, and late cancer stage at diagnosis. We reviewed the epidemiology, known risk factors and screening methods available in Israel and describe the Israeli national consortium that was established to identify persons at risk and decide on screening methods to detect and treat their early-stage pancreatic cancer. In collaboration with the Israel National Cancer Registry, we evaluated the incidence and trends of the disease in the Jewish and non-Jewish populations. The consortium reviewed known lifestyle risk habits, genetic causes, and screening methodologies used and available in Israel. Overall, there are about 600 new patients per year, with the highest incidence occurring in Jewish men of European birth (age-standardized rate 8.11/10(5) for 2003-06). The 5 year survival is about 5%. The consortium concluded that screening will be based on endoscopic ultrasonography. Pancreatic cancer patients and families at risk will be enrolled, demographic and lifestyle data collected and a cancer pedigree generated. Risk factors will be identified and genetic tests performed as required. This concerted national program to identify persons at risk, recommend which environmental risk factors to avoid and treat, and perform endoscopic ultrasound and genetic screening where appropriate, might reduce the incidence of invasive pancreatic cancer and/or improve its prognosis.
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Affiliation(s)
- Paul Rozen
- Department of Gastroenterology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.
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Abstract
BACKGROUND AND AIMS Liver diseases are associated with significant morbidity and health- related expenditure. Although cost-effective treatments are available, the disease is often asymptomatic until late in its course. "Medex Test," is the noninvasive detection of liver abnormalities by the measurement of changes in electrical impedance of dermal zones. This method is based on neuroreflexology, a branch of complementary medicine. This study addressed 2 questions: can Medex Test detect liver disease, and can it measure the severity of a known liver disease. METHODS This blinded case-control study included 2 parts. First, 113 patients with a known liver disease (hepatitis C, hepatitis B, and nonalcoholic fatty liver disease) and 85 controls with no known liver disease were evaluated by the Medex Test device. Second, necroinflammatory grading of biopsy results of 60 patients with chronic hepatitis C were compared with grade determined by Medex Test. RESULTS Medex Test detected with high sensitivity (85%) and specificity (94.1%) the presence of liver disorders. The high rates were similar for the different disorders and were independent of age and sex. Additionally, Medex Test matched the biopsy pathologic grading of necroinflammation in 78% of patients. Positive predictive value was not affected by age and sex and was better for higher degree of necroinflammation. CONCLUSIONS This pilot study demonstrated that Medex Test detects with high accuracy the presence of liver disorders and the necroinflammatory grade. This noninvasive, low cost test may in the future become an important tool in the diagnosis and management of liver disorders. We believe the further study of this novel method is warranted.
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Affiliation(s)
- Yoav Lurie
- Liver Disease Unit, Gastroenterology Institute, Tel-Aviv Sorasky Medical Center, Israel.
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